| NPI | 1144291246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 004416) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT004416) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2021-11-16 |